Published guidelines for resuscitation of extremely premature infants emphasize the importance of the gestational age of the infant. However, some ethicists and pediatricians have questioned these guidelines, suggesting that this may represent a form of discrimination. A policy of nonresuscitation of elderly patients older than a certain age would constitute a form of ageism and would likely be unacceptable to the broader community. Are resuscitation decisions for premature newborn infants analogous to resuscitation of elderly patients? Are current neonatal resuscitation guidelines discriminatory? This article looks at the relationship between discrimination based on gestational age and chronological age. There are 2 levels of gestational ageism and 2 separate strands of argument against gestational age guidelines. I conclude that resuscitation decisions for premature infants share many features with those for elderly patients, although there are also some relevant differences. I propose the use of gestational age equivalence as an alternative framework for practice.